Study On The Relationship Between Serum NPTX2 Levels And Post-stroke Cognitive Impairment And Functional Outcomes In Patients With First-episode Acute Ischemic Stroke

Part Ⅰ Relationship between serum NPTX2 levels and post-stroke cognitive impairment in patients with first-episode acute ischemic stroke Objection:Studies have shown that Neuronal pentraxin 2(NPTX2)is related to cognitive impairment.However,few studies have been published on the association between NPTX2 and post-stroke cognitive impairment(PSCI).Thus,this study aimed to analyze the correlation between serum NPTX2 levels and PSCI in patients with first-episode acute ischemic stroke(AIS).Methods:134 patients with first-episode AIS and 42 subjects of the control group were enrolled in this study.Clinical data were collected.The serum NPTX2 levels were determined by ELISA.All subjects were assessed for cognitive function using the Mo CA score after 3 months of onset.AIS patients with and without cognitive impairment were divided into the PSCI group and the PSNCI group,with a total Mo CA score < 26 defined as PSCI.SPSS 25.0 software was used to analyze the correlation between serum NPTX2 and total Mo CA score and subcognitive domains,the risk factors of PSCI,and the diagnostic value of serum NPTX2 expression level on PSCI.Results:(1)Incidence of PSCI: In 134 patients with AIS,53 cases were diagnosed with PSCI after stroke onset at 3 months,with an incidence rate of 38.8%.(2)Baseline information of the PSCI group,PSNCI group,and control group were compared:Hypertension,diabetes mellitus,dyslipidemia,history of smoking,history of alcohol consumption,WBC,FBG,HCY,and NPTX2 were statistically significant among the three groups(P < 0.05).In comparison among groups,serum NPTX2 levels were lower in the PSCI group than those in the PSNCI group,with statistically significant differences(0.83[0.67-0.91]ng/m L vs.0.91[0.73-1.11]ng/m L,P < 0.05);serum NPTX2 levels were higher in the PSCI group than those in the control group,with statistically significant differences(0.83[0.67-0.91]ng/m L vs.0.47[0.44-0.49]ng/m L,P < 0.05).In addition,compared with the PSNCI group,patients in the PSCI group had a higher proportion of dyslipidemia,higher admission NIHSS score,and m RS score at discharge,with a statistically significant difference(P < 0.05).(3)Comparison of 3-month Mo CA scores between the PSCI group,NPSCI group,and control group: there were significant differences in total MOCA scores among the three groups(P < 0.05).Between-group analysis revealed statistically significant differences in total Mo CA scores between the PSCI and PSNCI groups(P < 0.05).There was a statistically significant difference in total Mo CA score between the PSCI and PSNCI groups compared with the control group,respectively(P < 0.05).(4)Serum NPTX2 levels in AIS patients were positively correlated with 3-month total Mo CA scores after stroke onset(r = 0.329,P = 0.000).And analyzing the subcognitive domains of Mo CA,serum NPTX2 levels were positively related to visuospatial and executive functions(r = 0.273,P =0.001),naming(r = 0.178,P = 0.040),delayed memory(r = 0.289,P = 0.001),and attention(r =0.238,P = 0.006).No correlation was found between serum NPTX2 and language(r = 0.131,P =0.132),abstraction(r = 0.002,P = 0.978),and orientation(r =-0.045,P = 0.608).(5)The multivariate Logistic regression analysis showed that serum NPTX2 was independently associated with PSCI and serum NPTX2 was an independent protective factor for PSCI(P < 0.05).(6)Diagnostic value of serum NPTX2 on PSCI: the area under the ROC curve of serum NPTX2 was 0.643(95%CI: 0.550-0.737,P = 0.005),with a sensitivity of 88.68%,specificity of43.21%,and a cut-off value of <0.986 ng/m L.Conclusion:Higher levels of serum NPTX2 were observed in patients with first-episode AIS in the acute phase.Serum NPTX2 levels were positively correlated with cognitive functions.Lower levels of serum NPTX2 may be associated with impairment in visuospatial and executive functions,naming,delayed memory,and attention.Serum NPTX2 may be a potential biomarker for predicting the occurrence of PSCI in patients with first-episode AIS and lower levels of serum NPTX2 may be used as an adjunctive diagnostic biomarker for PSCI.Part Ⅱ Relationship between serum NPTX2 levels and short-term functional outcomes in patients with first-episode acute ischemic stroke Objection:Cognitive impairment is associated with the prognosis of stroke.The purpose of this study explored the relationship between serum Neuronal pentraxin 2(NPTX2)levels and short-term functional outcomes in patients with first-episode acute ischemic stroke(AIS).Methods:134 patients with first-episode AIS and 42 subjects of the control group were recruited.Clinical data were assessed.The serum NPTX2 levels were measured by ELISA.3-month prognosis after acute ischemic stroke onset was evaluated using the modified Rankin Scale(m RS)score.Functional outcome was defined as unfavorable(m RS >2).The correlation between serum NPTX2 and m RS score was analyzed using SPSS 25.0 software.The relationship between serum NPTX2 and a 3-month unfavorable prognosis in patients with AIS was analyzed.Results:(1)Baseline information of favorable functional group and unfavorable functional group:compared with the favorable functional group,the unfavorable functional group had lower serum NPTX2 expression levels,a statistically significant difference(P < 0.05).Patients in the unfavorable functional group had a higher proportion of hypertension and dyslipidemia,higher NIHSS scores and m RS scores at discharge,higher levels of hs-CRP,and statistically significant differences were obtained(P < 0.05).(2)Serum NPTX2 levels were negatively associated with m RS scores(r =-0.208,P = 0.016).(3)Logistic regression analysis: The univariate logistic regression analysis showed that serum NPTX2 level was associated with poor functional outcomes at 3 months(P = 0.027).Multivariate logistic regression analysis of variables with statistical significance for the univariate logistic regression analysis showed no significant correlation between serum NPTX2 levels and unfavorable outcomes for 3 months after stroke onset(P = 0.482).Conclusion:Serum NPTX2 levels were negatively associated with m RS scores,but no significant correlation was found between serum NPTX2 levels and short-term poor functional outcomes in patients with first-episode AIS.